FAQ - Off Exchange
Frequently Asked Questions
Open Enrollment runs from November 1 through December 15, 2018.
Open Enrollment is the yearly period when people can enroll in a health insurance plan.
Your policy will automatically renew each year as long as you continue to make your premium payments. If you would like to make changes to your policy, please contact our Sales Department.
Special Enrollment refers to a time period outside the annual open enrollment time frame. You could qualify for Special Enrollment if you recently had an altering life event and you would like to enroll or change a plan based on that event.
You may qualify for Special Enrollment if you've had a certain life event, including losing health coverage, moving, getting married, having a baby or adopting a child. You have 60 days following the life event to enroll in a plan. For additional questions regarding Special Enrollment qualifications, please contact our Sales Department.
Contact Community Health Choice Member Services and complete the Policy Termination Form to indicate changes.
You have 30 days to make changes to your policy from the date you first enroll.
Yes, you have the option of applying online, by completing a paper application, or in person at our Community Care Center.
You may be able to enroll outside of open enrollment if you meet special enrollment qualifications.
You will need to contact our Member Services Department at 713.295.6704 or toll free 1.855.315.5386 to report any errors or changes. This may require completing a new enrollment.
Each year, Community works hard to give you the doctors, hospitals, and special services you want at the best possible price. Unfortunately, as healthcare costs continue to rise, so must our premiums. We have other plans with similar benefits for you to consider that could save you money. When you compare apples to apples, we believe Community offers great value for your family’s healthcare dollars.
Your invoice is mailed to you once a month. You may also access your invoice via your My Member Account.
Monthly premium payments are due by the last day of the month prior to the start of the new month’s coverage.
You have 30 days to bring your account up to date.
The invoices are mailed out monthly at the beginning of the month before the start of a new the next month. For example, your January invoice will be mailed out in December.
You will need to submit proof using your bank statement either by fax or by uploading it to the My Member Portal.
Your health plan coverage becomes official when we receive your first payment, which takes care of your first month of coverage. You only have 30 days from the day you enroll to make your first payment and for it to post.
To set up recurring payments, you must create or login to your My Member Account, and follow the steps below.
Once you are logged in:
- Click on “Make a Payment"
- Click on “Manage Recurring Payments”
- Click on “Add new Automatic Payment “
- Fill in the information and select date, then click “Next”
- Confirm and Submit
- Your current charges include your monthly premium plus or minus any adjustments to your account.
- Your forwarded balance includes any previous unpaid balance.
- Your total amount due includes your current charges plus your forwarded balance, if there is one.
If you do not delete your recurring payments, they will roll over. We encourage you make any edits to your recurring payments as needed in your new enrollment.
The payment method will affect how long it will take to process your payment. If you made your payment by sending a check, it may take up to 10 business days for the payment to post. If you have made a payment with a credit/debit card, your payment may take 3-5 business days to process and be posted to your account.
We strongly recommend you make a payment only once, although multiple payments are acceptable. Please be advised that the full payment must be made before the start of the next month to avoid being in delinquent status.
We recommend that when setting up your recurring payments, your settings are set to Total Amount Due. This will ensure that the correct amount is drafted, even if your policy changes throughout the year. To set up auto payments please visit your My Member Account.
A Guide to Insurance Terms
An amount to be paid for an insurance policy.
A fixed fee that you pay for healthcare services and products (such as doctor visits and pharmaceutical prescriptions).
The amount you must pay for healthcare expenses before insurance covers the costs. Sometimes, a health insurance plan will have a yearly deductible that you must meet before coverage begins.
The amount you must pay for healthcare expenses after your deductible has been met. Coinsurance amounts are shared amounts between the health insurance carrier and you. Your portion of the coinsurance is paid until your out-of-pocket maximum is met for the year. Example: Joe has insurance that pays 80% of medical expenses. Joe has a doctor visit. The visit cost is $100. Joe pays $20 (coinsurance amount) and his insurance pays $80.
This is the maximum amount you will pay out of your own pocket in a year for covered healthcare expenses. Typically, after your out-of-pocket maximum expense limit is met, the plan pays 100% of all covered services for the remainder of the year.
A specified period of time when you can enroll in an insurance plan.
A Provider who is contracted with the health plan to provide services to plan Members for specific, pre-negotiated rates.
A Provider who is not contracted with the health plan.
A healthcare condition that existed before insurance coverage begins
A healthcare professional (usually a physician) who that is responsible for monitoring your overall health care needs.
A healthcare professional who specializes in one area of medicine. For example, a cardiologist is a doctor who specializes in heart conditions.